Are We Ready for This Change?
Why This Matters
Although potential benefits of an innovation may outweigh potential costs and risks, an organization may not be ready to implement the innovation. Before an innovation is adopted, it is important to consider organizational readiness for change. Receptivity to change among staff and patients may be instrumental in determining how successful an innovation ultimately will be.
Key Questions to Consider
- Is our staff open to change?
- How will other stakeholders react to the change?
For an innovation to be successful, support is needed at every level of the organization, from top leadership to front-line workers. Staff members' openness to change may be assessed by answering questions such as the following:
- What are staff members' values, attitudes, and beliefs about change?
- Is there a widespread perceived need to change among staff?
- Are staff members dissatisfied with how things are currently done?
- Do staff members think that the organization could be doing a better job?
- Do staff members believe that work is done inefficiently?
- Do staff members believe that there are inequities that need addressing?
- Do staff members think there are gaps in the services provided?
- Has the case for change been made effectively, using logic or data?
- How have staff members responded to similar changes in the past?
- Do staff members trust the people who will be leading the change effort?
- Who is most likely to resist change?
Tools for assessing readiness for change include staff surveys, comment cards, and focus groups. These tools can be used to gather information about staff attitudes about the status quo, about change in general, and about a particular innovation. Be aware, however, that reactions to a proposed change may differ from how people react to the actual change. Go to Can We Try the Innovation First? for information about testing a change.
The Asian Development Bank has developed a questionnaire that asks employees how ready they are for a planned change at http://www2.adb.org/Documents/Others/MFDR/Org-Questionnaire.pdf. (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software.)
The Institute of Behavioral Research at Texas Christian University conducted a staff survey of organizational readiness for change. Key domains included motivation for change, resources, staff attributes, organizational climate, and training exposure and utilization. To see the survey items, some of which are specific to substance abuse treatment settings and others that apply to other settings, go to http://www.ibr.tcu.edu/pubs/datacoll/Forms/orc-s.pdf.
The group visit model dramatically changes the roles of medical providers and support staff. Clinica Campesina assessed staff readiness for change before making the adoption decision. For details, refer to Sections 1.2 and 1.3 in the case studies in the Appendix.
Patients and families, board members, community organizations, and others have a stake in your organization. Ensuring that they have a positive attitude toward the innovation can be as critical to its success as obtaining staff cooperation. Refer to How will we implement the innovation? for more on conducting a stakeholder analysis. When assessing stakeholders' readiness to accept an innovation:
- Identify stakeholders affected by the innovation.
- Find out what their perceptions of the change are:
- What do they think will happen?
- How might they oppose the innovation?
- How might they support the innovation?
- What would constitute a “win” for them?
- Consider how you will involve stakeholders in the change process.
What Changes Will We Have to Make?
Why This Matters
All innovations require some degree of change. Some innovations require changes that go to the heart of the organization—changes in organizational structure, processes, and workforce. Anticipating the types of changes that an organization will have to make can help decisionmakers assess whether it is feasible to adopt a particular innovation.
Key Questions to Consider
- What structural changes will be needed?
- What process changes will be needed?
- What workforce changes will be needed?
- What other changes will be needed?
Organizational structure refers to the relationship among distinct units of an organization. Potential structural considerations include whether to:
- Create new departments or consolidate existing departments.
- Change lines of authority, responsibility, or accountability.
- Centralize functions that are currently decentralized, or vice versa.
- Change managers' span of control.
- Add or reassign staff.
- Create new teams.
- Outsource any functions:
- For questions about changes to physical plant and information systems, refer to What resources will we need to implement the innovation and what do they cost?.
- Work processes are how an organization gets its work done. Consider the innovation's potential impact on work processes.
- Will current work flows be disrupted?
- Will we need to modify standard operating procedures?
- Will we need to change decisionmaking processes?
- Will we need to alter communication (i.e., information flows) within the organization?
- Will work processes become more or less predictable?
- How will coordination, transitions, and handoffs be affected?
- Will we need to change our hours of operation or work shifts?
- Will we need to revise our performance measurement systems?
Decisionmakers at Clinica Campesina wished that they had considered how implementing a group visit model would affect the roles, responsibilities, and teaming of their care providers and support staff. Please refer to Section 1.2 of the case studies in the Appendix for a discussion of the changes that occurred.
Adopting an innovation usually requires some workforce changes, sometimes relatively minor and sometimes extensive. Ask yourself:
- Will we have to change staff roles or job descriptions?
- Will we need additional specialization?
- Will staff roles be diminished in any way (e.g., not using skills fully)?
- Will staff members' interactions with colleagues change?
- Will we have to change supervision or management practices?
- Will any staff be laid off?
- Will rules about seniority or job security be affected?
- Will we have to modify hiring processes?
- Will we have to change staff remuneration or performance recognition systems?
- Will we have to create new positions?
- Will we have to negotiate changes with our unions?
- Do staff members have the requisite skills to implement the innovation?
- How specific and complex are the knowledge/skills required?
- Do staff members have the capacity to acquire the necessary skills?
- Is there enough time for adequate training and skill development?
For more on training issues, see What are the potential costs?.
For a list of questions that staff members might ask about how change will affect them, check out the chapter on workplace change in Industrial Relations Victoria's High Performance Toolkit at http://www.business.vic.gov.au/operating-a-business/employing-and-managing-people/staff-management/changing-duties.
Although changes in structures, processes, and workforce are the most likely changes required to implement an innovation, other changes may be needed. Carefully consider the possibility of changes in other dimensions, such as:
- Patient relations.
- Community involvement.
- Finance or billing.
- Record keeping, accounting, and reporting.
Do We Have the Ingredients for Success?
Why This Matters
Many innovations fail despite careful planning. The innovation doesn't catch on or meets with resistance, people implementing the innovation stumble for lack of experience, or the amount of time it takes for successful implementation is underestimated. Decisionmakers can anticipate these pitfalls, learn from past innovation experiences, and determine whether they have the ingredients for successful adoption.
Key Questions to Consider
- Can we identify innovation champions?
- Where will we find the needed expertise?
- Can we do it in time?
- What can we learn from our past experiences with innovation?
If key colleagues within an organization support an innovation, then there is a greater likelihood that others within the organization will adopt the innovation (Backer and Rogers, 1998; Greenhalgh et al., 2004; Markham, 1998; Meyer and Goes, 1988). Before deciding to adopt an innovation, try to identify who could serve as champions who will be committed to implementing the innovation.
Potential champions include:
- Team or opinion leaders among staff who will use the innovation (clinical, management, business office, etc.).
- Staff who are enthusiastic about the innovation.
- Staff who occupy key roles (e.g., medical director, chief financial officer).
You should also consider whether your potential champions have the skills to be effective. Champions need to be able to:
- Generate support for the innovation.
- Bridge communication gaps.
- Foster collaboration.
- Overcome resistance to change.
- Problem solve.
Consider how you can help your champions be effective.
- Will they have an official role in the implementation of the innovation?
- Will they be released from other duties to work on the innovation?
- Will leadership demonstrate support publicly?
The Canadian Health Services Research Foundation summarizes four ways to identify opinion leaders at http://www.cfhi-fcass.ca/PublicationsAndResources/ResearchReports/articleview/08-03-01/86819997-7f24-440b-953d-bfc14f1fb259.aspx.
Decisionmakers at N.C. Children's Hospital emphasized that having a champion with high visibility, strong interpersonal skills, and willingness to cooperate with staff of other disciplines was critical to their success. Their champion served as a transformational leader, network facilitator, and change agent. Please refer to Section 4.4 of the case studies in the Appendix for details on how this champion supported the Pediatric Rapid Response Teams.
You may need expert support to implement an innovation. This expertise may be found in-house, or you may need outside help. The source of the expert support could have implications for timing and resources. Questions to consider include the following:
- What kinds of experts will be helpful to consult with before implementing the innovation?
- Will we need outside help or technical assistance? Where will we obtain the necessary resources?
- If we use consultants for expertise, how much help might we need before we are self-sufficient?
The American Planning Association's Deciding To Hire a Consultant lists reasons for hiring consultants and suggests how to find and select them. To access this tool, visit http://www.planning.org/consultants/choosing/part1.htm.
The time required for implementing an innovation must match your timetable for meeting your goals. You should consider the length of time it will take to prepare for implementation of the innovation, the length of time it will take to implement it, and the length of time needed to obtain results. Other considerations include the following:
- What sequence of tasks is involved in implementing the innovation?
- What is the anticipated timeline for accomplishing these tasks?
- Which tasks, if any, should occur simultaneously?
- Which tasks, if any, depend on the completion of other activities?
- Which, if any, of the tasks are considered to be urgent?
- What will be the consequences of falling behind schedule?
Several tools are available for charting the time a project will take to implement. For example, a Gantt chart can be a useful tool for:
- Planning tasks that need to be completed.
- Providing a schedule for completion of tasks.
- Facilitating a plan for allocation of resources needed to complete the project.
Critical path analysis (CPA) is another tool that can facilitate scheduling project tasks. CPA is more oriented around the sequence and interdependence of tasks than are Gantt charts. CPA is especially helpful for determining which tasks must be completed on time to avoid delaying the completion of the entire implementation and the minimum amount of time needed to complete implementation.
Additional information on CPA is accessible at http://www.mindtools.com/critpath.html.
Successful organizations learn from their experiences and apply that knowledge to improve performance. If your organization has adopted innovations in the past, you can use that experience to inform your current adoption decision by asking yourself:
- What prime factors were responsible for the success or failure of the innovation?
- Key players.
- Implementation strategies.
- Decisionmaking processes.
- How is the proposed innovation similar to or different from past innovations?
- Are any of the elements that were critical to success in the past missing this time? Is there any way to compensate for this absence?
- What can be done differently this time? Is this enough to make the innovation succeed when others have failed?
When considering adoption of the Crew Resource Management model to increase patient safety, Mt. Carmel Health System applied some lessons learned from the adoption of Six Sigma. They recognized the importance of having physician leaders engaged early to build support and buy-in; identifying measures of outcomes/impact early and tracking them over time; and using methods that supported budget-neutral innovation. Identifying a way to adopt the innovation at no net cost to the health system generated CEO and other key leadership support.